Provider Demographics
NPI:1114252699
Name:KINES, GARY DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DOUGLAS
Last Name:KINES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CALLE ELJARDIN
Mailing Address - Street 2:UNIT 201
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-6885
Mailing Address - Country:US
Mailing Address - Phone:904-849-3141
Mailing Address - Fax:
Practice Address - Street 1:140 CALLE ELJARDIN
Practice Address - Street 2:UNIT 201
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-6885
Practice Address - Country:US
Practice Address - Phone:904-849-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE709YMedicare PIN